Individual
DR. JACQUELINE SURESH LAYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
17324 GLENCOE AVE, LAKEVILLE, MN 55044-7429
(612) 718-0620
Mailing address
17324 GLENCOE AVE, LAKEVILLE, MN 55044-7429
(612) 718-0620
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1085359
TX
Other
Enumeration date
06/30/2020
Last updated
06/30/2020
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